The worst places to die — and why they export the world's carers

We fact-checked 1,041,387 medical migrants from 39 countries in 2020/21. Twelve countries stood out: the Philippines, Nigeria, Pakistan, India, Zimbabwe, Bangladesh, Nepal, Ghana, Kenya, Jamaica, Ethiopia, and South Africa.

They are the world's biggest exporters of healthcare workers, in order of magnitude. And our families back home pay the highest cost for end-of-life care while getting the worst quality of death.

The export/death paradox

The countries that train and send the carers the world depends on are the same countries where dying well is hardest. A nurse can deliver a good death every working day abroad — and still be unable to secure one for a parent at home.

Our free course The Worst Places to Die asks where that suffering concentrates, and why in these twelve countries — and not other poor countries. It walks through ten structural factors and the three feedback loops that lock them together, including which factors are most acute in your own origin country.

Death debt is structural

Approximately 85 million people across just these twelve countries are pushed into poverty by individual healthcare spending. The course puts a number on the total cost of dying — and shows why death debt is structural, rather than a family's failure.

The suffering is growing

The number of people dying with unaddressed severe pain is estimated to multiply two and a half times — to 20.1 million a year by 2060.

Who these countries share

All twelve share collectivist family values: an individual does not face mortality alone, end-of-life decisions are deeply relational, and generations are financially interdependent. That is exactly why care planning built for a single patient doesn't fit — and why we build for the whole family.

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